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F Giammarile, C Houzard, C Bournaud, Z Hafdi, G Sassolas and F Borson-Chazot

OBJECTIVES: Somatostatin receptor scintigraphy (SRS) with (111)In-octreotide has been suggested as a potential tool for the detection of recurrent or metastatic differentiated thyroid cancer when no radioiodine uptake can be demonstrated in tumour sites. However, there is no consensus concerning the performance and clinical impact of this examination in such instances. DESIGN AND METHODS: A prospective study was undertaken to evaluate SRS in 43 patients (18 men, 25 women) with papillary (n=20), follicular (n=9), insular (n=6) and oncocytic (n=8) thyroid carcinomas with elevated serum thyroglobulin (Tg) levels and no detected radioiodine uptake. RESULTS: Evaluation criteria were interpreted in terms of an assumed presence of tumoural tissue. Sensitivity of SRS was 51%, clearly lower than that of conventional imaging procedures, and of positron emission tomography using [(18)F]-2-fluoro-2-deoxy-d-glucose, performed in a subset of 27 patients. In addition, we observed two false-positive foci of uptake of octreotide that corresponded to inflammatory pulmonary sites. The sensitivity was higher in patients with Tg levels greater than 50 microg/l (76%) for detecting mediastinal lesions (93%), and in patients with oncocytic cancer (88%). Finally, SRS changed treatment strategy in four patients. CONCLUSION: In differentiated thyroid cancer, SRS is a moderately sensitive method for the detection of lesions unable to concentrate iodine and appears useful only in patients with very high Tg levels or in oncocytic cancer.

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F Giammarile, Z Hafdi, C Bournaud, M Janier, C Houzard, C Desuzinges, R Itti, G Sassolas and F Borson-Chazot

OBJECTIVE: Dedifferentiation of thyroid cancer leads to an inability of thyroid cells to concentrate iodine. In these cases, imaging methods that allow an accurate detection of recurrence and/or metastases at an early stage are essential for an adequate management of patients. Positron emission tomography using [18F]-2-fluoro-2-deoxy-d-glucose and a dedicated (dPET-FDG) or non-dedicated (nPET-FDG) camera has been suggested as a potential tool for the detection of tumour foci. DESIGN AND METHODS: This prospective study was undertaken to evaluate nPET-FDG in 51 consecutive patients (18 men, 33 women) with differentiated thyroid cancer (33 papillary, 11 follicular, four insular and three oncocytic (Hurthle-cell) thyroid carcinomas). Selection criteria were high thyroglobulin (Tg) levels (>10 ng/ml off-levothyroxine treatment) and no detectable radioiodine uptake, on a whole body scan performed with a high dose, in the absence of iodine contamination. RESULTS: Results were interpreted in terms of assumed presence of tumoral tIssue. Sensitivity of nPET-FDG was similar to that of conventional imaging modalities (67%). False negative nPET-FDG (n=16) were observed mostly in cases of micro-lesions (lymph nodes or lung metastases). Conversely, nPET-FDG identified new tumoral sites in 11 cases. Better sensitivity was found for nPET-FDG in patients with Tg levels higher than 15 microg/l (P<0.05). On a patient basis, results of nPET-FDG were equivalent to that of dPET-FDG. Finally, nPET-FDG changed treatment strategy in seven patients. CONCLUSIONS: nPET-FDG has a high sensitivity for the detection of tumour sites in patients when pathological iodine uptake cannot be demonstrated and appears to be a useful method in patients with elevated Tg levels, especially when dedicated PET is either unavailable or impractical.